She was presumed dead.

— Then she woke up in a body bag gasping for air.

This Iowa hospice care facility was fined $10,000 for mistakenly pronouncing a woman dead when she was still alive.

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As the nurse at the hospice care facility in Iowa checked on the 66-year-old woman, it was clear to the caregiver the patient was dead.

The nurse found no pulse, movement or signs of life in the woman, who had been admitted to Glen Oaks Alzheimer’s Special Care Center in Urbandale, Iowa, for early onset dementia in late December, and “felt the resident had passed away,” according to a report from the Iowa Department of Inspections and Appeals this week.

But after the patient was placed in a body bag and transferred to a funeral home, there was one problem: The woman woke up. And she was desperately trying to breathe. “Funeral home staff unzipped the bag and observed Resident #1’s chest was moving and she was gasping for air,” the report said of the woman, who was not identified by the agency. “The funeral home then called 911 and hospice.”

After EMS personnel recorded her pulse but no other movement or motor response, the patient was transferred to a hospital. Two days after returning to the hospice facility that had mistakenly presumed she was dead, the woman died with her family by her side on Jan. 5, according to the state report published Wednesday.

Now, the hospice facility has been fined $10,000, the maximum allowed under state law, for mistakenly pronouncing the woman dead. The state cited in its report the facility “failed to provide adequate direction to ensure appropriate cares and services were provided.” The agency added the hospice facility failed to ensure the patient received “dignified treatment and care at end of life.”

Lisa Eastman, executive director of Glen Oaks Alzheimer’s Special Care Center, did not immediately respond to a request for comment Friday. Eastman said in a statement to the local CBS station in Des Moines the hospice facility cooperated and completed the investigation from the Iowa Department of Inspections and Appeals. She noted the facility has also been in “close communication with the family of the resident.”

“We care deeply for our residents and remain fully committed to supporting their end-of-life care,” Eastman said. “All employees undergo regular training so they can best support end-of-life care and the death of our residents.”

While it is rare for people to be incorrectly declared dead, it has happened before. In 2018, a Spanish prisoner was certified dead by three doctors before waking up in a mortuary. Later that year, a car crash victim in South Africa was covered in a silver sheet and taken to a morgue when a forensic officer noticed the person was still breathing. In 2020, a Michigan woman was about to be embalmed after she was pronounced dead from a heart attack until employees at a funeral home saw her breathing.

Glen Oaks, a state-licensed residential care facility, is not a skilled nursing facility, meaning it is not subject to the same oversight and federal regulations as nursing homes, according to the Iowa Capital Dispatch. The facility was fined $500 last year for failing to perform required background checks on employees after five workers did not have the mandated training.

The outlet reported that while the Iowa Department of Inspections and Appeals believes people living in a state residential care facility are unable to properly care for themselves, those residents “do not require the services of a registered or licensed practical nurse except for emergencies.”

If Glen Oaks does not contest the citation and pays the $10,000 fine within 30 days, then it will be reduced by 35 percent, according to the state administrative code. The patient was admitted to the facility on Dec. 20, 2021, after she was diagnosed with early onset dementia, anxiety and depression, according to the state report. She was admitted to hospice care about a year later, on Dec. 28, 2022, because of “senile degeneration of the brain,” the report said.

It was 6 a.m. on Jan. 3 when a nurse found no signs of life while checking on the patient, who is referred to by the state agency as “Resident #1,” the report said. “Resident #1’s mouth was open, her eyes were fixed and there were no breath sounds,” the report said. “She was unable to locate Resident #1’s apical pulse using her stethoscope. She placed her hand on Resident #1’s abdomen and noted no movement.”

After a few minutes, the nurse “felt the resident had passed away” and presumed the patient was dead, according to the report. The nurse then notified a family member and the on-call hospice nurse. “Hospice agreed to call the funeral home and did so,” the report said.

At 7:38 a.m., a funeral director arrived to retrieve the patient’s body and place it “on the gurney inside a cloth bag and zipped it shut,” according to the state report. Almost an hour later, staff members at the funeral home realized the woman was still very much alive when they saw her chest moving.

She was transported to an emergency room where officials noted that her breathing was shallow, according to the report. The woman was released that same day and returned to the hospice facility “with continued hospice care around the clock,” the agency said in the report. Two days later, she died surrounded by loved ones. This time, it was real.

Complete Article HERE!

A Good Death

— Instruction manuals for living written by the dying

By Kristen Martin

Adina Talve-Goodman lived with an awareness of her own mortality that most of us will never approximate. Born with a single-ventricle heart and pulmonary atresia—a condition where the valve that controls blood flow from the heart to the lungs doesn’t form—she had two surgeries in her first week of life alone. By four, she had undergone two open-heart operations; by twelve, she was in heart failure. “I was a happy kid even though I did not know what wellness felt like,” Talve-Goodman explains. After spending nearly two years on the waiting list for a new heart—a process she describes as “an exercise in how close you can get to death”—she received a transplant in 2006, at the age of nineteen. With her new heart, she adjusted to blood that coursed quickly through her body, pinking her previously pallid cheeks, affording her energy and strength she had never before known.

Talve-Goodman dreamed of publishing a collection of essays exploring her experience of chronic illness and approaching the brink of death, informed by critical theories of embodied difference, suffering, and disability. Eleven years after her heart transplant, when she was drafting those essays in the University of Iowa’s nonfiction MFA program, she was diagnosed with a rare form of lymphoma caused by the immunosuppressants that kept her body from rejecting its new heart. She died six months later, in January 2018, at thirty-one. 

Now, Talve-Goodman’s collection is here, though it is not the book she hoped would be her debut. Your Hearts, Your Scars brings together seven essays, all but one unfinished at the time of her death. In the introduction, her sister Sarika describes the collaborative process behind the book, one that its author did not take part in. “When Adina’s cancer treatments were starting not to go well, she said to me with a sadness and softness that she hadn’t even gotten to publish a book,” Sarika writes. “Of course she would, I said . . . I wish I had responded differently in that moment of openness. Maybe we could have talked about what she had wanted and worked on it together.” Instead, after Talve-Goodman died, her sister read and organized everything she had ever written and compiled a manuscript. Together, Talve-Goodman’s parents, both rabbis; the editorial team she had worked with at One Story for six years (Hannah Tinti, Patrick Ryan, and Maribeth Batcha); and her best friend since childhood, the comedian Jo Firestone, edited her words into “a book made out of love and grief.”

Books like Talve-Goodman’s bring us visions of death, but they do not bring us any closer to understanding it.

The essays that make up Your Hearts, Your Scars come in at just over one hundred pages and are rooted more firmly in the personal than the critical: Talve-Goodman writes about attending a summer camp for teenage transplant recipients in San Diego, before she got her new heart, where she met kids who “carr[ied] the weight of dead donors”; about the Thanksgiving when she held her old heart in her hands, having requested to take it home from the hospital; about realizing that she “might never feel as if being healthy and having energy is normal.” The essays are suffused with compassion and hope, but given the circumstances of publication, the overall effect is achingly bittersweet.

In this juxtaposition of the author’s clear-eyed appreciation for life that comes with being close to death and the reader’s ever-present awareness that the author is now, in fact, dead, Your Hearts, Your Scars joins a lineage of instruction manuals for living written by the dying. The most recent spate of such books hit shelves in the years leading up to the pandemic, before death became all too present and we shunned confronting mortal reality in favor of smarmy calls for resilience. The neurosurgeon Paul Kalanithi’s 2016 memoir When Breath Becomes Air, written in the months leading up to his death of lung cancer at thirty-seven, kicked off a renewed interest in posthumously published meditations on death, hitting the top of the New York Times bestseller list and garnering critical acclaim. The next year brought Cory Taylor’s Dying, which Barack Obama named as one of his favorite books that year, and Nina Riggs’s The Bright Hour, which the Washington Post hailed as “this year’s When Breath Becomes Air.” In 2019, Julie Yip-Williams’s The Unwinding of the Miracle, adapted from a blog she kept called My Cancer Fighting Journey, joined the pantheon, a little less than a year following her death at forty-two. It, too, drew comparisons to When Breath Becomes Air (Kalanithi and Yip-Williams shared an editor at Random House).

What unites all these posthumous memoirs is the hunger we bring to them as readers. We expect koan-like wisdom on what matters in life, an enlightened perspective gained from being at or near the end of it. We expect to come away transformed, in possession of the same moral clarity that their authors have achieved by dying. Back cover blurbs demand that readers heed the authors’ lessons: Atul Gawande—the author of Being Mortal, a book about end-of-life medicine—claims that “Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.” Ann Hood says Cory Taylor’s Dying “should be required reading for all of us.”

The ultimate lesson we hope to learn from these books? How to live meaningfully while knowing that life must end, and when it does end, how to face death with equanimity. Put simply, we want to learn how to die.

I have lived most of my life preoccupied with mortality, wishing that I could understand what it is like to die, to be dead. When I was twelve, my mother died of lung cancer; my father died of prostate cancer two years later. In the decades since, I have stopped believing in an afterlife—my parents are nowhere but in memory. Instead, I have tried to understand their deaths in a way I couldn’t when they were dying, and tried to understand death more broadly, through reading literature published from beyond the grave. Books like Talve-Goodman’s bring us visions of death, but they do not bring us any closer to understanding it.


Instead of this year’s When Breath Becomes Air, perhaps a maudlin blurber might call Your Hearts, Your Scars this year’s The Opposite of Loneliness—so far, this century’s paradigmatic work by an author who died before fully developing her craft. The book’s very existence fetishizes the idea that those who die young are especially insightful and worthy, which is in turn part of an impulse to make trite meaning of a life cut short.

Like Talve-Goodman, Marina Keegan was not consciously composing a manuscript to be read posthumously. She died in a car accident days after her graduation from Yale. The 2014 book— put together by Keegan’s family, friends, and her mentor at Yale, Anne Fadiman—takes its title from a piece Keegan wrote for commencement, which developed a tragic weight after her death because its pep talk no longer applied to her: “What we have to remember is that we can still do anything. We can change our minds. We can start over . . . The notion that it’s too late to do anything is comical. It’s hilarious. We’re graduating college. We’re so young.” The Opposite of Loneliness, which hung around the New York Times bestseller list for weeks, drew praise for its “youthful optimism, energy, honesty, and beyond-her-years wisdom.”

Talve-Goodman’s wisdom, on the other hand, comes from having experienced what it was like to die before she died, a fact that colored her image of the future. Though each essay has an undercurrent of brightness, Your Hearts, Your Scars is not a feel-good look at sickness and dying. (This jibes with the fact that the book is out from Bellevue Literary Press, an indie publisher with roots in the historic New York City public hospital that focuses on the intersection of the arts and sciences and exploring the human condition.) What Talve-Goodman’s loved ones have ultimately given readers in publishing her words is a perspective on chronic illness and survival that pushes back on the idea that people who suffer must inspire us or teach us gratitude.

When she died, Talve-Goodman was on the cusp of a literary career; she had only published one piece, an essay titled “I Must Have Been That Man,” which won the 2015 Bellevue Literary Prize in nonfiction. (Coincidentally, Fadiman was the contest’s judge.) That essay, which opens Your Hearts, Your Scars, recounts how Talve-Goodman traversed from illness to wellness forever marked by her near-death, a theme woven throughout the collection. As with many of the other pieces, “I Must Have Been That Man” is built around an incident that happened when Talve-Goodman was in college in St. Louis. She writes of being locked out of her apartment on a rainy day about a year after her heart transplant and coming across a man in the street who had fallen out of his electric wheelchair. It’s a story about the difference between compassion and pity, but the crux is in a reflective moment toward the beginning:

When I listed [for transplant], my parents, both rabbis, told me a story from the Talmud about a rabbi who goes to visit three sick men and each time the rabbi asks, “Is your suffering dear to you?” “That’s the whole story,” they’d explain, “and it’s the question that’s important.” I took it to mean this: When the time comes, will you be able to live without the heart defect that always made you special and strong? Will you be able to face wellness and normalcy?

Talve-Goodman realizes that her suffering is dear to her, at least, she writes, “a little bit.”

Reading the essays that follow, I thought about how the popularity of death memoirs speaks to how the suffering of others is dear to us. In “Your Hearts, Your Scars, Zombies,” a meditation on the cultural figure of the zombie that her sister notes is the closest to the melding of the personal and the critical that she aspired to publish, Talve-Goodman confronts the appetite well people have for stories about sickness: “What, then, for an illness narrative? Perhaps that I am what you make of me—I live this way, a different body, a body of hybridity, to mean something to you, to your experiences, to practice your empathy, to fetishize, even to ‘inspire.’” It’s a refreshing moment of reprimand against a tendency to read illness—or death—narratives with a posture of self-serving pity and a desire to extract encouragement. 

And still, reading Your Hearts, Your Scars, I found myself asking for more than its author wanted to—or could—give. I wished that Talve-Goodman had gone deeper on death—that she had taught me more about how to die. In the collection’s final piece, “Thank God for the Nights That Go Right,” Talve-Goodman lingers on what it felt like to almost die, as opposed to having made it out on the other side, feeling like what she at one point describes as “death in drag.” She writes of being tired, being desperate, being close to giving up the night before she learned that she would receive her transplant. “I always thought dying would feel worse,” Talve-Goodman writes. “I thought there would be more pain, I thought death would be clear.” What did dying feel like? I wrote in the margin, wanting to vicariously understand through reading something that literature cannot deliver.


After reading Your Hearts, Your Scars, I revisited Kalanithi’s When Breath Becomes Air to remind myself of why all these posthumous memoirs get stacked up against it, and why publishers have tried to recreate its success: it actually does meditate cogently and vigorously on what makes life meaningful, even and especially with the acute knowledge of imminent death.

But Kalanithi didn’t start that line of inquiry in his final months—it was a lifelong pursuit, one he began while studying literature and biology in college in an effort to understand both “the life of the mind” and “the rules of the brain.” He chose medicine because he felt it was where “biology, mortality, literature, and philosophy intersect[ed],” and because he believed it would allow him to directly “forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” In performing neurosurgery, working on and in the organ that makes us individuals—the brain—Kalanithi further challenged himself to confront, along with his patients, “what makes life meaningful enough to go on living.” This was a man who dedicated his entire career to grappling with the fundamental questions of life.

There is value in reading death memoirs, if we can take them on their own terms.

Ironically, within When Breath Becomes Air, Kalanithi makes the argument that literature cannot teach us how to die—something I missed in my first reading, and that the market for books like Kalanithi’s has chosen to ignore. Early on, he writes, “I had spent so much time studying literature at Stanford and the history of medicine at Cambridge, in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me.” Later, after facing death through his patients—which taught him the limits of accessing someone else’s experience—and after receiving his own diagnosis of stage IV lung cancer, Kalanithi turns back to books, reading “anything by anyone who had ever written about mortality.” He tells his oncologist that he’s doing so, “trying to find the right perspective.” She replies, “I’m not sure that’s something you can find by reading about it.”  

What Kalanithi ultimately learns is that he must decide for himself what he values in life, what makes his own life worth living, where he finds meaning. We each have to do this hard work when the time comes. Even with all of the meditative homework Kalanithi completed ahead of time, it wasn’t until he was dying that he could truly answer these questions, and his answers shifted along with his prognosis, his symptoms, his energy.

But still, there is value in reading death memoirs, if we can take them on their own terms. When Breath Becomes Air cannot prepare us to face our own mortality or bring us closer to comprehending the purpose of life or what it means to die. It can, though, allow us inside one man’s personal and philosophical end-of-life reckoning, which may in turn spur our own reflections. Similarly,Your Hearts, Your Scars cannot be an instruction manual for “living each day as a gift,” as the back cover claims that Talve-Goodman did. It can be a slim volume of words about coming-of-age that a young writer never got to polish to her satisfaction, shared as part of her legacy.

Complete Article HERE!

Comparing green funeral options

— From composting to natural burial to water cremation

Throwing a funeral that leaves Earth a bit better off, maybe

By

I’m standing at the summit of Fernwood Cemetery just outside San Francisco. Live oaks sprout from the hills like leafy castles. A red-tailed hawk turns circles in the sky above me. And below me, hundreds of bodies are slowly returning to the earth. This vista takes in one of the largest natural burial sites in California. Every person here (or their loved ones) decided that their last act should be as green as possible.

My own mother died in July with no instructions on how she wanted to be laid to rest. My sister and I faced wrenching weeks planning her funeral. We had to navigate a disorienting “death care” marketplace, as the industry is called. I faced the unenviable task of sorting through options such as Titan Series Steel Casket, Bahama Blue Granite Cross Grave Markers and something called the Athena Urn Vault. These were only the accessories. Securing a burial plot in my area — even with just a shroud and no headstone — could cost $15,000.

Overwhelmed, my family finally chose a simple cremation, scattering my mother’s ashes in a small park under a Monterey pine. Cremation was not the most climate-friendly choice, but it felt like the best we could do in the crush of the moment.

Dying in modern America has never presented so many difficult (or expensive) choices. Tradition once circumscribed us. In the 20th century, 95 percent of Americans had one kind of death ritual: embalming and then viewing the body in a funeral setting, says Shannon Dawdy, a University of Chicago anthropologist.

But a distinct shift is underway in how we approach death. More than half of Americans are seeking greener funerals, according to the National Funeral Directors Association, and the percentage is rising. The funeral industry is responding: You can now be entombed in a coral reef. Donated to science. Freeze-dried and shattered into thousands of pieces. Set adrift in an ice urn. “Purified” by mushroom suits. Or, in a return to the past, simply buried in your backyard.

A snow-covered grave at Herland Forest, a natural burial cemetery in Wahkiacus, Wash., on Saturday.

What makes a funeral green? I found lots of claims — and a few studies — about the things that make a meaningful difference for the environment. The search also raised some discomforting questions: Just how open was I, for example, to dissolving my body in a vat of lye? (I’m in. I think.)

So I’ve marshaled the best available evidence to help you make a more informed decision for yourself, or someone else. The most important step, no matter what you choose, is just to start. In the United States, only 24 percent of Americans plan their own funeral. That leaves it up to your loved ones during one of the most difficult times in their lives.

Here’s your chance to decide.

Casket burial vs. cremation

For Jacquelyn Day Hovakimian, 35, a librarian in Lakewood, Calif., her funeral was too much to face. She wanted her death to leave the world a bit better, “but every time I initially tried to look into it, I got too emotional,” she said. “Oh God, death. But the more I faced it, it took away the taboo and emotions, and I could make a logical and unbiased decision for myself.”

She eliminated the idea of cremation or an elaborate coffin burial. While these account for 94 percent of all funerals in the United States, they are also the worst for the environment. Each year, cemeteries in the United States use 64,000 tons of steel and 1.6 million tons of concrete — enough to rebuild the Golden Gate Bridge — in addition to more than 4 million gallons of embalming fluid, according to the nonprofit Green Burial Council.

Each cremation, which incinerates bodies with propane torches, emits greenhouse gas emissions equivalent to driving 500 miles in a car. Both methods are relatively new, having displaced millennia-old traditions of simple shrouds or pine coffins in just the past century or so.

“The modern American way of death is really a post-Civil War phenomenon,” says David Sloane, an urban planning professor at the University of Southern California and author of the book Is the Cemetery Dead? “And it’s clear modern funerals are the worst environmental polluter by far.”

Human composting

Next, Hovakimian looked into human composting. This method places human remains into a steel vessel with nothing more than water, heat, mulch and preexisting microbes, accelerating natural decomposition. After about 45 days (and some turning of the vessel), the body becomes a cubic yard of nutrient-rich soil and bones.

Tom Harries, the founder of Earth Funeral, an Auburn, Wash.-based firm offering the service, says “soil transformation” has been done for all ages, from fetuses to centenarians. The soil is returned to loved ones or spread across reforested land on Washington’s Olympic Peninsula, where soil and trees absorb carbon dioxide from the air.

A “cradle” is used for natural organic reduction at Herland Forest.
A body inside the “cradle.”

The environmental impact is negligible, consuming about 40 gallons of water and a modest amount of electricity. Human composting is already legal in California, Washington, Oregon, Vermont and Colorado, as well as for anyone willing to ship a body to those states.

Natural burial

Natural or green burials account for a tiny but growing share of all funerals in the United States. Bodies are buried in a shroud or biodegradable caskets made of wood, bamboo or cardboard. No embalming, grave liners or conspicuous headstones are allowed.

Some cemeteries offering green burials may protect and restore wildlife habitat, while others, such as Life After Life in Brooklyn, plan to turn industrial brownfields and urban sites into cemeteries serving local communities with new parks. Natural burials, like human composting, have minimal environmental impact — perhaps even positive. The Green Burial Council estimates the process sequesters 25 pounds of carbon dioxide while avoiding energy-intensive mowing, fertilizing and watering.

The tree canopy at Herland Forest.
Walt Patrick, senior steward of Herland Forest, visits his own grave at the natural burial site. Patrick placed a stone from his time in Nevada to mark the site.

There’s no single standard for natural burials, but at least 368 cemeteries offer them in the United States, while some state organizations will help you plan a burial on your property. You can also hire someone like Elizabeth Fournier, known as the “Green Reaper,” an independent undertaker in Oregon and author of the Green Burial Guidebook.

Water cremation (alkaline hydrolysis)

None of these options worked for Hovakimian. Human composting wasn’t available in her state at the time, and she felt a burial plot, however green, would make it hard for her family to “let go.”

Instead, she picked a process called alkaline hydrolysis, or water cremation, through the California-based company Pisces. The technique, first used by funeral homes around 2011 and legal in about 28 states, immerses bodies in a vat of hot, highly alkaline water (95 percent water, 5 percent potassium hydroxide). The soft tissues dissolve within a few hours. The resulting tea-colored liquid — a sterile mix of salts, sugars and amino acids unwound from DNA — is safe to pour onto the ground as fertilizer, or down the drain. As in conventional cremations, the bones are ground up into a fine powder.

The roughly four-hour process uses a modest amount of electricity and water (about 400 gallons). While a bit more expensive than conventional cremations, greenhouse gas emissions from the process are negligible.

For Hovakimian, choosing water cremation “was incredibly easy.”

“I’d rather put less crap in the air, and maybe leave the place a little better for the future,” says the librarian, whose family came around to the idea after initial resistance. “It also just seems a little nicer than being set on fire.”

Measuring the impact of a green funeral

How can you pick what’s right for you? Consider your culture and whether you want something traditional — knowing today’s “traditional” funerals date back, at most, to just after the Civil War, says Sloane.

For perspective, consider the work of Dutch sustainability researcher Elisabeth Keijzer. She has tabulated the environmental impact of everything from the cotton lining in coffins to the emissions from driving a hearse. Not all emissions, or effects, are direct. Composting and alkaline hydrolysis do not directly emit much greenhouse gas, but building the facilities where they take place consumes significant energy.

Given these differences between funerals (and countries), it was hard to pin down exact numbers for each process. But in a 2017 study, Keijzer found a clear pattern: Burials and cremations had the largest impact, particularly on the climate, while options such as human composting or green burials were much lower, if not dramatically different from one another.

Ultimately, she questioned the focus on funerals entirely. Compared to other activities during a person’s lifetime, the climate change impact of a funeral is “very small,” she wrote. The most carbon-intensive conventional burial represents just over 0.03 percent of the average Dutch citizen’s lifetime emissions. In the United States, where per capita emissions are about twice as high, this share would probably be even lower.

Ultimately, one eco-friendly burial will not outweigh a lifetime of emissions. So choose a green funeral, if you wish. But from a climate perspective, the way you live will always eclipse what happens after you die.

Complete Article HERE!

More and More, I Talk to the Dead

By Margaret Renkl

After my mother died so suddenly — laughing at a rerun of “JAG” at 10 p.m., dying of a hemorrhagic stroke by dawn — I dreamed about her night after night. In every dream she was willfully, outrageously alive, unaware of the grief her death had caused. In every dream relief poured through me like a flash flood. Oh, thank God!

Then I would wake into keening grief all over again.

Years earlier, when my father learned he had advanced esophageal cancer, his doctor told him he had perhaps six months to live. He lived far longer than that, though I never thought of it as “living” once I learned how little time he really had. For six months my father was dying, and then he kept dying for two years more. I was still working and raising a family, but running beneath the thin soil of my own life was a river of death. My father’s dying governed my days.

After he died, I wept and kept weeping, but I rarely dreamed about my father the way I would dream about my mother nearly a decade later. Even in the midst of calamitous grief, I understood the difference: My father’s long illness had given me time to work death into the daily patterns of my life. My mother’s sudden death had obliterated any illusion that daily patterns are trustworthy.

Years have passed now, and it’s the ordinariness of grief itself that governs my days. The very air around me thrums with absence. I grieve the beloved high-school teacher I lost the summer after graduation and the beloved college professor who was my friend for more than two decades. I grieve the father I lost nearly 20 years ago and the father-in-law I lost during the pandemic. I grieve the great-grandmother who died my junior year of college and the grandmother who lived until I was deep into my 40s.

Some of those I grieve are people I didn’t even know. How can John Prine be gone? I hear his haunting last song, “I Remember Everything,” and I still can’t quite believe that John Prine is gone. Can it properly be called grieving if the person who died is someone I never met? Probably not. But when I remember that John Prine will never write another song, it feels exactly like grief.

In any life, loss piles on loss in all its manifestations, and I find myself thinking often of the last lines of “Elegy for Jane,” Theodore Roethke’s poem about a student killed when she was thrown from a horse: “Over this damp grave I speak the words of my love: / I, with no rights in this matter, / Neither father nor lover.”

Why, when we grieve, can it feel so urgent to make others understand the depth of our loss, even when we have no rights in the matter? I think it must be because people so often fail to honor grief at all. We talk of “processing” loss, of reckoning with it and moving on, as though bright life could not possibly include an unvanquishable darkness. Our culture persists in treating mourning as an unpleasant process we are obliged to endure while waiting for real life to restore itself.

But God help anyone who appears to move on too quickly, or too slowly, for the grief police will be coming for them. They may be accused of giving their late spouse’s clothes away too soon, or of mourning excessively a relationship that seems too far down the grief ladder to justify such a response. People have opinions about how others should manage loss.

Just before my mother died, I heard her say to a stranger, “My husband died nine years ago, and every night I tell God I’m ready to see him again.” Four days later, she got her wish.

I’m in no hurry to join my beloved dead, but like my mother before me, I am spending more and more of my days in their company. As my father was dying, and taking so long to die, I feared that the memories of his brutal last years would overwhelm four decades of happy times. I worried that the father who followed me into my own old age would be the fretful, pain-wracked old man and not the loving optimist who had always been my surest source of strength in an indifferent world.

It didn’t turn out that way. Next month he will have been gone for 20 years, but he is as real to me today as he was on any day of the 41 years we shared on this side of the veil.

I read a newspaper article reporting that NASA will be dismantling the Saturn rocket that rises above the Alabama welcome center on I-65 South, and I remember the model Saturn rocket, taller than my 10-year-old self, that Dad and I built together from chicken wire and papier-mâché. I hear a Cole Porter song on the radio, and I remember my parents dancing in the living room. I see a blue jay perched in the pine tree just outside our family room, and I recall how often I was told that “blue jay” is the first bird I learned to call by name. There were so many blue jays in so many pine trees back in those days when I was still a cherished late-born child, and my parents were still explaining the world to me.

It’s the same with all my lost beloveds. Reminders take every possible form — the feel of pine needles underfoot, the scent of a passing woman’s perfume, the tail end of a song on a coffee shop radio, a letter tumbling out of a long-unopened book, the taste of boiled peanuts, salty and warm. The reminders loop between past and present, between one lost loved one and another, a buzzing sweep of sensations and memories and time. I keep searching for the right metaphor to convey what I mean. Is it like a braid? A web? A shroud?

Finally the word comes to me: It’s a conversation. Every day, all day long, everyone I’ve ever loved is gathered around the same table, talking.

Ten years on, I rarely dream about my mother anymore, but in the dreams where she does appear, it’s the same as before — the ordinariness of life, the rush of relief I feel, her blithe unawareness of my suffering. I walk in the door, and there she is, there they all are, no happier to see me than they would be if I’d only walked in from another room in the same house. In my dreams, as in my waking life, the dead are still here, still talking to me.

Complete Article HERE!

If you could, would you want to know when you will die?

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Would you want to know when you’re going to die? I’ve thought about this question quite a bit recently.

>Several months ago, I picked up a new novel titled “The Measure” by Nikki Erlick, which opens with quite the plot twist. One morning, everybody on the planet (ages 22 and up) wakes up to a surprise at their front door: a small wooden box, personally engraved, with the words: “The measure of your life lies within.” Each box contains a string whose length determines the length of the recipient’s life.

The characters now face a gut-wrenching decision. Do they open the box and find out how long they will live? If yes, what will they do with that knowledge? If not, which means they’re choosing not to know, will they live any differently?

The question is not entirely a hypothetical one. A few months ago, out of a morbid curiosity, I visited Death Clock, a website that labels itself the “Internet’s friendly reminder that life is slipping away … second by second.”

I entered the month, day and year of my birth, my gender, mood (from pessimistic to optimistic), whether I smoked tobacco, and my height and weight. I hit the submit button, and a second later came my answer: “Your personal day of death is Wednesday, April 23, 2031.”

If true, I had nine years to live; I’d be a few months short of my 74th birthday.

About the same time, my sister, who is 60 and being treated for advanced ovarian cancer, was told by her oncologist that time may be running short. Of course, it was only a doctor’s guess and her current chemo regimen has significantly improved her tumor markers. Regardless, she’d be considered a “short stringer,” one of those who will die before their time, in “The Measure.”

I’ve wanted to be a “long-stringer,” ever since I had cancer in my 20s, but thanks to Erlick’s book and now my sister’s illness, I’ve recognized that focusing on exactly when my time is up is unknowable and probably not particularly good psychically. So I’ve decided instead to focus on how I want to spend those years, not just the number of them.

In any case, longevity doesn’t come with a guarantee of good health, and those “bonus years” may hold less value if confined to home or suffering from debilitating conditions.

As the characters in “The Measure” discover, a long string (meaning many years of life) does not equal happiness. And while the characters who get short strings initially feel as though they’ve come up, well, short. gradually, they find greater meaning and richness in their comparatively fewer days. Their newfound knowledge alters their perspective on what matters.

One of the novel’s characters, Nina, who is married to one of the short stringers, says: “It’s easy to look at our time together and think that we were so unlucky. But isn’t it better to spend ten years really loving someone, rather than forty years growing bored or weary or bitter?”

After her partner, Maura, dies — indeed early — Nina explains that their relationship “felt deep, and it felt whole, despite its length. It was an entire, wonderful tale in and of itself.”

All this brings me back to my little sister, Julie, and the deep angst I feel at what may turn out to be a premature death. I want her to live forever. (Maybe not forever, but, please, longer than me!)

To help me with these stomach-wrenching feelings, I’ve turned to friends, my therapist, a higher-dose antidepressant, meditation, ketamine and Elisabeth Kübler-Ross’s work on the five stages of death and dying. All of which work — some.

Oddly enough, “The Measure” has provided me with a greater sense of peace and acceptance than I’ve found anywhere else. Don’t get me wrong, I still hate that Julie is likely to live fewer years than her older brother. But I’ve watched and learned as Julie has lived as big a life as anyone could imagine. This proved true before her diagnosis but even more so in recent years.

Soon after her diagnosis, Julie emailed me to say that she’d already had a full life, even if it’s cut short. Since then, she has focused on what matters to her — seeing her daughters graduate from college, celebrating 35 years with her wife, going away on trips with the whole family, visiting with close friends.

In other words, Julie has fine-tuned those relationships that mean the most to her and not dwelled on those that she may miss out on in the future.

I remember thinking at our recent Christmas dinner about a quote attributed to Ralph Waldo Emerson: “It is not the length of life, but the depth of life” that matters. And then I thought about what Nina, in the novel, tells us: “When we think about the greatest love stories ever written, we aren’t judging them by their length … . [A]nd even though I’ve been given more chapters than Maura, her pages were the ones you couldn’t put down. The ones that I’ll keep rereading, over and over, for the rest of my life. Our decade together, our story, was a gift.”

Amen.

It’s not about how many chapters we’ve lived but how rich and exciting those chapters are. Or, as the late poet Mary Oliver wrote, “Tell me, what is it you plan to do with your one wild and precious life?”

For starters, I’m not going to listen to the Death Clock. I don’t want to know when I’m going to die — but I do want to live each day as though it could be my last.

Complete Article HERE!

How different cultures deal with grief and mourning

A group of colourfully dressed women mourning a death in India.

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Grief is a universal emotion. It’s something we all feel, no matter where we come from or what we’ve been through. Grief comes for us all and as humans who form close relationships with other people, it’s hard to avoid.

Studies of grieving brains – be it scans of the brain regions which process grief, or measures of the stress hormone cortisol that is released in grief – show no differences in relation to race, age or religion. People of all cultures grieve; we all feel sorrow, loss, and despair. We just do it – and show it – in different ways.

James Averill, a US professor of psychology, has compared this to sexual feelings which, like grief, are biologically driven but expressed in elaborately different social contexts.

Here are several examples that demonstrate how grief and mourning can look very different depending on where you live and come from.

1. Collective grief is common

When it comes to grieving in the west, the focus is often placed on the individual. People talk about their personal grief, and counselling is usually arranged for just one person – even support groups are attended by individual members. But the reality is that the family – or for many Indigenous people, the tribe – grieves collectively, and in some cultures this is more pronounced than others.

In Hindu families in India, for example, relatives and friends come together to support the immediate family in an elaborate 13-day ritual. A widow ceases to be the head of the household and her place is taken by the wife of her oldest son.

Typical of Native American culture, the Lakota tribe elders use the phrase “mitakuye oyasin”, meaning “we are all related”. The death of anyone in the tribe is felt by all.

Scrolls with names in Chinese script to honour dead relatives.
Scrolls with names in Chinese script to honour dead relatives.

In Tibet, the Buddhist mourning period following a funeral lasts 49 days. During this time the family gathers to make clay figures and prayer flags, allowing for a collective expression of grief.

Collective grief is also the norm in traditional Chinese culture, but here the family also makes collective decisions – which sometimes exclude the dying person. This was seen in the 2019 film The Farewell, which was based on director and writer Lulu Wong’s real life. In the film, a Chinese family discovers their grandmother has only a short time left to live and decides to keep her in the dark, scheduling a wedding in order to gather before she dies.

2. Grieving times vary by culture

After a bereavement, a steady return to normal functioning can typically take two or more years. Experts no longer talk of “moving on”, but instead see grief as a way of adapting to loss while forming a continuing bond with the lost loved one. But again, this varies from culture to culture.

In Bali, Indonesia, mourning is brief and tearfulness is discouraged. If family members do cry, tears must not fall on the body as this is thought to give the person a bad place in heaven. To cry for too long is thought to invoke malevolent spirits and encumber the dead person’s soul with unhappiness.

People walking along road in colourful clothing.
Traditional funeral and cremation ceremony in Ubud in Bali, Indonesia.

In Egypt, tearfully grieving after seven years would still be seen as healthy and normal – whereas in the US this would be considered a disorder. Indeed, in the west, intense grief exceeding 12 months is labelled “prolonged grief disorder”.

3. People like to visit the body

The way people interact with the dead body also differs culturally. For example, between the death and the funeral, the Toraja people on the island of Sulawesi, Indonesia, treat their relative as if they were ill rather than dead, by bringing them food and keeping them company.

Women Catholic devotees wearing traditional mourning dress
Women Catholic devotees wearing traditional mourning dress.

Europe has its own customs. In the UK until the mid-20th century, along the Yorkshire coast, the lying-out of the body was done by women of the village. Friends and family would come to view the deceased, pay their respects, and recall memories of the person. This practice continues in some countries.

In Italy, for example, a temporary refrigerated coffin is delivered to the family home so people can bring flowers and pay their respects in the immediate aftermath of the death.

4. Signs from above

In the UK, some people believe that white feathers are a message from heaven, though this is often dismissed as childlike magical thinking. But in many African societies, spiritual connection to the deceased is considered normal and very real.

In sub-Saharan Africa, the traditional belief is that the dead become spirits but remain in the living world on Earth. They are thought of as the living dead. The spirit may appear in dreams in their human form.

Voodoo altars representing the spirits of the dead people.
Voodoo altars representing the spirits of the dead people in Benin, West Africa.

5. Sending on the spirit

The Māori people indigenous to New Zealand set aside time to grieve and mourn. They perform rites for the dead in a process called “tangihanga”. First, rituals send on the spirit, then the body is prepared by an undertaker, often helped by family members. The body returns to the family home for the family to reminisce in celebration.

Mourners with wreaths on their heads.
Throughout the tangihanga, mourners dress in black and wreath their heads in kawakawa leaves.

Elaborate rituals follow, including dances and songs and finally a farewell speech. Traditional artefacts including clothes, weapons and jewellery are displayed. After the funeral, there is a ritual cleansing of the deceased’s house and feasting, before an eventual unveiling of the headstone.

Complete Article HERE!

I Helped My Mother To Live and Later Die

— After begging her mother to live longer, this author later honors her mother’s wishes for how she wanted to be treated at the end of her life

Kathleen and her mother, less than two years before Mary Elizabeth’s death

By Kathleen M. Rehl

“Please don’t die now, Mom! I can’t handle two funerals back-to-back.”

In a panic, I squeezed my mother’s hand as I sat beside her bed. The hallway’s stark white light streamed through her doorway. Announcements crackled over an intercom as an equipment cart clattered past her room. Mom’s roommate moaned in her sleep before returning to rhythmic snoring.

Then, finally, a sweet-faced nurse’s aide said I could stay beyond regular visiting hours. Staring intently before she spoke, Mom said, “Your father came to me in a dream last night and told me it was time to let go and be with him again.”

Mom Loved Her New Life

Flashback to Dad’s death from colon cancer, a few days after his 80th birthday. After he passed, Mom moved over 1,000 miles from her house on a dusty, isolated road to live near me and my husband, Tom, in Florida.

She blossomed like the red roses she cared for near her apartment.

Leaving sadness and grief behind, she chose a sunny independent living apartment in a continuing care retirement community (CCRC). There she blossomed like the red roses she cared for near her apartment.

Mom made new friends fast, joined afternoon card games, shelved books at the community library, tended a meditation garden, participated in church activities, baked yummy chocolate chip cookies to share, traveled to visit a few relatives across the country, and enjoyed an occasional happy hour glass of sangria with girlfriends.

In addition, Tom and I included Mom in many local activities. “I love my new life here,” she often said. Mom’s newfound happiness lasted almost two years.

Life Changed

A serious fall interrupted Mom’s joyful journey. After spending Thanksgiving with Tom and me, my mother fell in her apartment, shattering her femur. Mom’s next-door neighbor’s frantic phone call brought the ambulance.

At the hospital, we authorized emergency orthopedic surgery. A few days later, she transferred to her CCRC’s skilled nursing care wing, with weeks of physical therapy scheduled. Her spirit was crushed.

I was devastated, of course, but the knockdown punch to the gut hit in early December. That’s when my husband visited his doctor, feeling unusually tired, with jaundiced skin and abdominal pain. He called me at work later, saying he’d been admitted to the hospital for specialized testing.

I bolted from my desk and didn’t return to it for many weeks. Meetings and phone calls with a medical staff filled our coming days. By week’s end, we knew his diagnosis was a callous killer — late-stage inoperable and untreatable liver cancer.

His prognosis was death within a few months. My 72-year-old husband chose home hospice care rather than a war he couldn’t win.

Mom Rallied

“All right! I won’t die now,” Mom said from her nursing home bed when she understood Tom’s death sentence. And that’s just what she did.

Mom mustered her petite body’s life force, willing her health to improve.

She completed prescribed physical therapy, navigated with her fractured leg plus a walker, and moved back into her apartment with daily assistance from an aide and friends.

I boomeranged between caring for my mother and my husband. Then, Tom’s progressive downward spiral gathered speed while Mom’s condition stabilized. He died in my arms on February 12, 2022 with my brother beside us both.

A packed church celebrated my husband’s life. Mom sat near me as I stood in the funeral’s receiving line, both brokenhearted.

Years Before, We Talked About Care Preferences

“I don’t want you kids to have to pull the plug on me someday,” Mom said over a decade before.

Several years before Dad’s death, our family discussed health care preferences if we experienced a severe illness. My mother had once carried the burden of being the one who authorized disconnecting her aunt and mother from life support after each suffered debilitating strokes.

“I didn’t know what they would have wanted because we never talked about topics like that back then.”

“I didn’t know what they would have wanted, because we never talked about topics like that back then,” she said. Mom felt she “killed Aunt Frances and your grandmother.”

Dad, Mom, Tom, and I completed the Five Wishes advance care planning document years before we updated our estate plans. It’s easy to understand, covering one’s personal, spiritual, medical, and legal wishes at the end of life.

In addition, it identifies the person designated to make care decisions when you can’t do it yourself. After my father passed, Mom revised her plans, naming me the primary health care agent.

The Beginning of Mom’s Ending

After my mother told me about her dream of Dad, she didn’t speak of that vision again until Tom died. Then her health plummeted within a month. Complications put her in the hospital again.

Two older adults getting off a bus. Next Avenue, caregiving for mom
Mom and Tom in St. Petersburg

That’s when she repeated that Dad was preparing to welcome her. She wanted to go. Tearfully hugging my mother, I told her it was OK. I understood. I wouldn’t hold her back.

They requested my mother’s advance health care documents when she was admitted to the hospital. I gave them a copy of her Five Wishes form, verifying she didn’t want life support treatment to keep her body alive when she was close to death.

Even though this paperwork was accepted and filed, Mom’s plans were almost upset when she went into immediate cardiac arrest in the middle of the night. Finally, exhausted, I left her hospital room to go home for a shower and a few hours of sleep. But a hospital nurse called after midnight, saying they were taking Mom to the intensive care unit (ICU) for life support.

“No! That’s not what she wants! Read her advance care directives!” I yelled over the phone. “I’ll be there as fast as I can. Please don’t move Mom!”

I pulled on my jeans and raced for the car, driving in the dark over the speed limit. I ran to her room with a copy of Mom’s Five Wishes form. Assistants started rolling her bed into the hall on the way to the elevator and the ICU.

Committed to Her Wishes

The nurse said she needed to get the doctor. He looked over the forms, stepped away for a few minutes, and returned to ask what I wanted. “Plain palliative care, please!” I answered.

I encourage you to avoid heartache and upset as you consider what you want and do not want for your end-of-life care.

Fast forward. That’s precisely what happened, with my mother moved into a private hospice care room. My brother and I were allowed to camp with her in that room for the remaining three days of her life.

We facilitated a few short phone calls with her family, sang to her, read her favorite scriptures, and monitored her morphine. Then, before slipping into her final slumber, she told us of a clear new vision, where she saw relatives waving from across a bridge and preparing for a party.

“They have to wait for me to cross over that bridge before starting the festivities,” she said. Tom and my Dad were in that welcoming crowd, along with her mother and aunt. She finally said, “Awesome!” as she crossed her bright bridge.

Most Don’t Have End-of-Life Conversations

In June 2020, the National Poll on Healthy Aging was conducted for the University of Michigan’s Institute for Healthcare Policy and Innovation. A sample of U.S. adults aged 50–80 was asked about their advanced care planning.

Nearly two in five adults aged 50–80 had not discussed their health care preferences if they experienced a severe illness. More than two in three hadn’t completed an advance directive and durable power of attorney documents.

More than half of the folks who had not talked about their care preferences with others or completed related legal documents said it was because they needed to take the time to do this.

I encourage you to avoid heartache and upset as you consider what you want and do not want for your end-of-life care. I hope my story encourages conversations with you and your loved ones. It’s a precious gift you can give them.

Complete Article HERE!